Capitalizing on ongoing battles over insurance coverage of abortion in the wake of the enactment of health care reform, antiabortion activists are laying out an aggressive political, communications and legal road map for the future direction of their movement, according to a new Guttmacher analysis. The goal is to further separate abortion from mainstream health care, at both the federal and state levels.
"Antiabortion advocates have unveiled a radical agenda aimed at eliminating abortion coverage from any health insurance plan that in any way touches a public dollar, whether directly or even indirectly under the tax code," says Susan A. Cohen, author of the new analysis. "This approach goes far beyond the Hyde amendment prohibitions on direct abortion funding under Medicaid, harmful as they are, to implicate even private-sector, employer-based group insurance plans."
According to Cohen, this aggressive push is well under way in the states, which, under the new health care law, are allowed to prohibit or encourage abortion coverage in private plans. Thus far, 12 states have introduced bills to ban abortion coverage in state-level health care exchanges, and five of them—Arizona, Louisiana, Mississippi, Missouri and Tennessee—have enacted such bans.
"In states where abortion coverage in exchange health plans will still be permissible, it remains an open question whether insurers will still offer it, for both practical and political reasons," says Cohen. "Reproductive health advocates will need to help policymakers and the public at large understand that abortion is a not only a legal, but a constitutionally protected health care service that will be used by one in three American women by the time they turn 45. It is at least as deserving of insurance coverage as any other medical service."
Meanwhile, abortion rights opponents have opened a second front at the federal level, where Rep. Chris Smith (R-NJ) and some 165 cosponsors introduced legislation in July that would take the argument against funding abortion to new extremes. Among other new lines of attack, the legislation would prevent employers from taking a tax deduction for insurance plans that include abortion coverage or withholding their employees’ pretax dollars to pay premiums for plans that cover abortion.
"Antiabortion activists are aggressively using the bill as a whole to demagogue against abortion as health care and, when the new Congress convenes, they have promised to look for legislative openings to advance its various individual provisions," says Cohen. "It’s clearly an attempt to keep abortion rights advocates on the defensive and stop them from working to reverse some of the damage done to abortion rights during health care reform."
The new analysis also recapitulates the heated debate on insurance coverage of abortion that played out during health care reform. As Cohen notes, the setback for abortion rights within this context only brings into sharper focus the long-standing struggle that the poorest U.S. women have faced for decades when it comes to funding restrictions that impede their access to abortion services.
"Abortion care is health care, for both poor women who rely on Medicaid and for women who are privately insured," says Cohen. "Reproductive health advocates must forcefully make the case that, as a matter of equity and fairness, abortion should be acknowledged, covered and reimbursed as health care—whether under public or private health insurance."
Click here for "Insurance Coverage of Abortion: The Battle to Date and the Battle to Come," by Susan A. Cohen, in the Fall 2010 issue of the Guttmacher Policy Review.